CDC issues new guidance on closure of schools and childcare
facilities related to the H1N1 influenza virus epidemic

On May 5, HHS Secretary Kathleen Sebelius and
Acting CDC Director
Richard Besser announced new CDC guidance on closure of schools and
childcare facilities where there have been reported cases of the
novel H1N1 flu virus. The new guidance was developed in
consultation with top scientists at the CDC and some of the top
public health departments across the country. A statement by
Secretary Sebelius and Acting CDC Director Besser follows in its
entirety.

Since the beginning of this outbreak, the CDC has been working to
update, or in some cases, quickly develop interim guidelines to
help healthcare providers, health departments, and communities take
effective action to prevent the spread of this novel H1N1 virus.
Our interim guidelines are guided by science, based on available
data, and designed so that resources and efforts are directed
toward actions and activities that make a difference in preventing
spread of this virus.

Today, we are announcing a change with respect to CDC's interim
guidance on closing schools and childcare facilities. The initial
guidance CDC issued on May 1st recommended that affected
communities with laboratory-confirmed cases of influenza A H1N1
consider adopting school dismissal and childcare closure measures,
including closing for up to 14 days depending on the extent and
severity of illness. At the onset of this outbreak of a previously
unknown influenza virus, we believed it would be helpful to close
affected schools while we learned more about the virus's
transmission and the severity of disease. Further, the U.S.
national strategy for pandemic influenza suggested that ongoing
community-wide closure of all schools and daycare centers should be
considered in the event of a severe outbreak, especially if these
measures could be implemented early.

As CDC's daily press briefings have illustrated, much has been
learned quickly about the virus's severity and its spread. We have
learned that in many communities, the virus is widely circulating.
When influenza becomes common in a community, it is unlikely that
actions such as closing schools or daycare facilities are effective
when it comes to slowing or stopping the spread of influenza
viruses. Instead, such measures bring significant cost--such as
interrupting student learning--without a significant public health
benefit. In addition, we have learned that the disease currently
being caused by this novel flu virus appears to be similar with
that typically caused by seasonal influenza. Although many people
may get sick, the available data do not indicate we are facing an
unusually severe influenza virus.

With the modified policy being issued today, CDC no longer
recommends that communities with a laboratory-confirmed case of
influenza A H1N1 consider adopting school dismissal or childcare
closure measures. Rather, in line with policies being undertaken in
Seattle, New York, and Canada, CDC has modified its policy to
recommend implementation of measures that focus on keeping all
students, faculty, and staff with symptoms of influenza out of
schools and childcare facilities during their period of illness and recuperation, when they are potentially infectious to others.

More specifically, at this time, CDC recommends the primary means
to reduce spread of influenza in schools focus on early
identification of ill students and staff, staying home when ill,
and good cough and hand hygiene etiquette. It is imperative that
schools and parents reiterate this message. Students, faculty, or
staff with influenza-like illness (fever with a cough or sore
throat) should stay home and not attend school or go into the
community except to seek medical care for at least 7 days even if
symptoms resolve sooner. Students, faculty, and staff who appear to
have an influenza-like illness at arrival or become ill during the
school day should be isolated promptly in a room separate from
other students and then sent home.

It's important to note that schools that were closed based on
previous interim CDC guidance related to this outbreak may reopen.
That said, decisions about school closure should be at the
discretion of local authorities based on special circumstances and
local considerations, including public concern and the impact of
school absenteeism and staffing shortages.

Some have asked whether the World Health Organization might raise
the pandemic phase alert from 5 to 6 and how that might affect our
school closure and other community mitigation recommendations. As
we have stated previously, it is important to note that the WHO
pandemic phase designation is based on geographic spread of the
influenza virus, not on the severity of the illness. In the event
that sustained transmission is found in another part of the world,
it is not unlikely that WHO would raise the level to 6.
Furthermore, from the beginning, we have assumed an aggressive
public health approach to this outbreak. For those reasons, should
a phase 6 alert designation be made, it would not affect our
guidance on school closure in particular or raise our concerns on
the virus more generally.

We appreciate the efforts that communities, particularly school
districts, have taken to protect students and staff from this
influenza A H1N1 virus. Communities and schools are at the
forefront of protecting people's health, and we are committed to
providing them the flexibility they need to deal with local
conditions, and the best possible guidance that reflects our most
current understanding of the scientific and medical facts.

To access the revised guidelines from CDC, "Update on School (K-12)
and Childcare Facilities: Interim CDC Guidance in Response to Human
Infections with the Novel Influenza A (H1N1) Virus," go to: http://www.cdc.gov/h1n1flu/K12_dismissal.htm

CDC's web page titled Swine Flu: Interim Guidance
for Clinicians &
Public Health Professionals has recently been updated with more
interim guidance documents. Following are the titles and URLs of
guidance documents that have been added or revised since the last
IAC Express Extra Edition of May 1, excluding the school closing
document discussed in the first article of this issue.

CDC has also posted interim guidance on such topics as screening,
specimen collection, facemask and respirator use, travel, and
emergency personnel. To access the web page, which is constantly
evolving, go to: http://www.cdc.gov/H1N1flu/guidance

To aid visitors looking for H1N1 influenza
information, IAC has
developed a brand new section of related resources on its main
website.

The main page for important information related to H1N1 influenza
(swine flu) can be accessed at http://www.immunize.org/h1n1

The new section includes H1N1 influenza guidance documents from CDC
on prevention and patient care for the public and healthcare
professionals, including information targeted to pregnant women,
persons with medical conditions, school and childcare facilities,
employers, and much more. The page also features a video on hand
washing produced by CDC. You may wish to bookmark the main page, http://www.immunize.org/h1n1, for ease in referring to it later.

The following subsections can be accessed from the main page above,
or directly with the following links:

A collection of articles published in peer-reviewed journals
related to H1N1 influenza or general pandemic influenza.

IAC also features a handy box on the top of its home page that
provides a link to this new section, as well as to CDC, HHS, and
other important sources of H1N1 influenza information. Look for the
box titled "H1N1 Flu (Swine Flu)" at the top of http://www.immunize.org

This website is supported in part by a cooperative agreement from the National Center for Immunization and Respiratory Diseases (Grant No.
6NH23IP22550) at the Centers for Disease Control and Prevention (CDC) in Atlanta, GA. The website content is the sole responsibility of IAC and does not necessarily represent the official views of CDC.